A New Multiplane Dissection Method for Frontotemporal Lift and Fixation.

Lifting procedures of the upper face have gained significant popularity, and various methods and dissection planes have been described. The deep temporalis fascia (DTF) is a crucial structure for securing lifting sutures and allowing horizontal tissue vectorization. However, achieving vertical eyebrow lifting often requires bone maneuvers and introduces potential complications. This letter proposes a novel multiplanar dissection method for the temporal and forehead regions, obviating the need for bone maneuvers in lifting suture fixations. The presence of the subgaleal fascia in the temporal region has been identified, in addition to the DTF and superficial temporal fascia. Furthermore the superficial temporal fascia is divided into 3 layers, with attention paid to their medial connection with the structures of the forehead. Surgical techniques involve meticulous dissection down to the DTF and identification of the subgaleal fascia for lateral temporal dissection or transition to the subplane of the epicranial aponeurosis for forehead lifting. By leaving a thick layer, the subplane of the epicranial aponeurosis during forehead lifting eliminates the need for drilling and reduces the risk of relapse. The described multiplanar dissection method enhances the safety and effectiveness of forehead lift procedures, offers a viable alternative to bone drilling, minimizes flap-related complications, and provides valuable insights for facial rejuvenation surgery.

Histopathological Evaluation of Bipolar and Microneedle Radiofrequency Energy on the Skin and Fat of the Abdominal Region of the Rat.

BACKGROUND: Radiofrequency (RF)-based devices are frequently used in plastic surgeries. In the current literature, no comparative experimental study has demonstrated the histological and immunological effects of these devices that are frequently used in the facial area. In this study, we investigated the histological and immunological effects of Bipolar RF (BodyTite) and Microneedle RF (Morpheus 8) devices in the rat abdominal region. METHODS: 24 rats were used in this study. The rats were divided into four groups: group I: Control. In group II, BodyTite was applied to the abdominal region. Group III: Morpheus 8 was applied to the abdominal region. Group IV: Both Morpheus 8 and BodyTite were applied to the abdominal region. The histological and immunological features of the tissues in the groups were examined using light microscopy, and collagen formation and desmosome structures were examined using light microscopy. RESULTS: Collagens in Group II were thinner than those in the other groups. In addition, there were fewer vessels in Group III. The collagen scores were as follows: Group II:1.5; Group III:2; and Group IV:3. The VEGF scores were II:2.5, group III:2, and IV:3, respectively. The collagen score in group II and VEGF score in group III were significantly lower than those in the other groups. In addition, the bonds between desmosomes in group III were found to be looser using electron microscopy. Collagen morphology in groups III and IV was found to be similar to that in group I. CONCLUSIONS: The conclusion of comparison RF-based devices increased tissue regeneration and healing. CLINICAL RELEVANCE STATEMENT: The use of radiofrequency devices has increased in plastic surgery practice over the past two decades, particularly emerging as a unique alternative for non-surgical candidates. There is a lack of experimental studies concerning these commonly used devices in clinical practice.

Evaluation of graphene oxide-doped poly-lactic-co-glycolic acid (GO-PLGA) nanofiber absorbable plates and titanium plates for bone stability and healing in mandibular corpus fractures: An experimental study.

BACKGROUND: Open reduction with internal fixation is the preferred treatment option for displaced facial bone fractures. The superior mechanical properties of metallic plates have made them the most widely used material in existing bone fixation systems. However, after the healing period, these permanent plates can cause various problems. Alternative bioresorbable materials are being investigated to reduce these potential problems. This study compares bone stability and viability by using graphene oxide (GO)-doped poly-lactic-co-glycolic acid (PLGA) nanofiber plates and titanium plates for rats with fractured mandibles. MATERIALS AND METHODS: The study included 20 male Sprague-Dawley rats, divided into four groups: a control group (Group I), a mandibular fracture group with no additional application (Group II), a mandibular fracture group repaired with titanium plates (Group III), and a mandibular fracture group repaired with GO-PLGA plates (Group IV). After 2 months, all of the rats were euthanized. A bone compression test was performed to assess bone stability, and a histological examination was performed to evaluate bone healing. RESULTS: The osteocyte lacunae, Haversian ducts, canaliculi, and vascular structures of Group IV were found to be higher. In the compression test, vertical compression was applied to the bone axis, and Group IV had a higher maximum load and maximum stretch. GO-PLGA plates were found to be statistically superior to titanium plates in terms of both bone stability and bone healing (p < 0.05). CONCLUSIONS: The present study found that GO-PLGA plates are more effective than titanium plates for the treatment of mandibular corpus fractures.

Reconstruction of finger contracture with an expanded first dorsal metacarpal artery perforator flap: A case report.

Volar finger contractures can be challenging for plastic surgeons. The dorsal metacarpal artery perforator (DMCAP) flap is frequently used to cover bones, tendons, and neurovascular structures in the dorsum of the hand after trauma and burns as an alternative to grafts and free flaps. We aimed to report volar finger defect reconstruction with expanded DMCAP flap. A 9-year-old male patient applied to our clinic with the complaint of inability to open the second finger of the left hand after an electrical burn that caused proximal and distal interphalangeal joints flexion contractures. Reconstruction was planned for the patient with a two-session expanded first DMCAP flap. A 16 mL 5 × 3 cm tissue expander was placed in the prepared area from the vertical incision in the first session. The tissue expander was inflated with 4 mL of isotonic solution. The DMCA area was enlarged 6 weeks later by giving 22 mL of isotonic solution. After the pedicle dissection, the 9 × 3 cm DMCAP flap was elevated by dissection over the paratenon. With 180° of rotation, the left-hand second finger was adapted to the 6 × 2 cm defect area on the volar face. The flap donor site was closed primarily. The operation was terminated by placing the hand on a protective splint. There were no complications in the flap in the postoperative 6 months. The patient was referred to the physical therapy and rehabilitation department. As a result, an expanded DMCAP flap may cover volar tissue defects up to the distal phalanx. This report may present the first case in which volar finger contracture reconstruction was performed with an expanded first DMCAP flap after an electrical burn in a pediatric patient.

Comparison of Dorsoulnar Artery Perforator, Superficial Palmar Branch of the Radial Artery, and Superficial Circumflex Iliac Artery Perforator Flaps in Volar Finger Defects.

BACKGROUND: Volar finger defects can sometimes be challenging for plastic surgeons. There are many reconstruction options from local flaps to free flaps. Therefore, the aim of this study was to present a functional and cosmetic comparison of the results of using dorsoulnar artery perforator (DUAP), superficial palmar branch of the radial artery (SPBRA), and superficial circumflex iliac artery perforator (SCIP) flaps for repairing volar finger defects. METHODS: Thirty-two patients were included in the study. The age and sex of the patients, cause of injury, defect location, defect size, and presence or absence of nerve damage were noted. The patients' defects were reconstructed with DUAP, SCIP, or SPBRA flaps. The flap size, flap elevation time, vessels, and early postoperative complications were noted. During the postoperative follow-up period, the Michigan Hand Outcomes Questionnaire scale was used to evaluate hand function, and the modified Vancouver Scar Scale was used to assess aesthetic appearance. Two-point discrimination tests and cold intolerance tests were performed to measure sensory outcomes. Donor site improvements were also noted. RESULTS: There was no significant difference between the groups in terms of age, defect size, flap size, follow-up time, and 2-point discrimination. It was observed that the elevation time was significantly shorter in the SCIP flap group, and the Michigan Hand Outcomes Questionnaire score was significantly lower in the DUAP flap group compared with the other 2 groups (P < 0.01). In addition, the modified Vancouver Scar Scale score was significantly higher in the DUAP flap group (P < 0.01). CONCLUSION: The findings of this study show that the use of SPBRA flaps has more advantages than the use of DUAP and SCIP flaps in many respects.

Histological and Immunological Evaluation of the Osteogenic Effects of Compact Bone-Delivered Stem Cell on Spongiosis Bone in the Rat Zygomatic Arch Defect Model.

BACKGROUND: In stem cell applications, apart from bone marrow and adipose tissue, compact bone is also used as an alternative. However, studies on this subject are limited. In our study, we investigated the effect of stem cell derived from compact bone on rat zygomatic arch defect. METHODS: Fifteen rats were included in the study. Five rats were killed to obtain stem cells before the experiment. The rats were divided into 2 groups with 5 rats each. In group 1, compact bone-derived stem cell was applied. In group 2, adipose tissue-derived stem cell was applied. Right zygomatic arch defect was created in rats in both groups. Zygomatic bones were decellularized by cryosurgery. Stem cells were transferred to zygomatic bones. The number of stem cells, stem cell differentiation, and superficial markers obtained from the groups were examined. Histologically, cell structure, osteocyte count and osteopontin scores, elemental composition of the groups, percentages of resemblance to intact bone, osteocytes numbers, and cells were examined by electron microscopy of the bones in the groups after killing. RESULTS: The number of stem cells administered to the groups was 5 × 107 and 3.2 × 107 for group 1 and group 2, respectively (P > 0.05). Histologically, the morphology of the cells in group 1 was found to be healthier than group 2. The number of osteocytes was 97.56 ± 15.4 and 132.93 ± 10.8 in group 1 and group 2, respectively (P < 0.05). The osteopontin score was 3.47 ± 0.73 and 65 ± 0.64 in group 1 and group 2, respectively (P < 0.05). In the electron microscope examination, the morphologies of the cells in group 1 were seen more normal. The Ca/P ratio of the groups was 1.51 and 1.59 in group 1 and group 2, respectively (P > 0.05). Osteocyte counts were 10.7 ± 2.8 and 6.1 ± 1.2 in group 1 and group 2, respectively (P < 0.05). Morphological similarity percentages to normal bone were 88.4% and 79.6% in group 1 and group 2, respectively (P > 0.05). CONCLUSION: Stem cells obtained from compact bone gave positive results in zygomatic arch defect. This method can also be used as an alternative in stem cell applications.

Utilization of Perifascial Loose Areolar Tissue Grafting as an Autologous Dermal Substitute in Extremity Burns.

BACKGROUND: Perifascial areolar tissue (PAT) is an areolar layer over the muscle fascia. PAT has been shown to be resistant to ischemia and prone to survival even in ischemic conditions. PAT grafts provide a vascular tissue layer on necrotic bone and tendons where skin grafting is not possible. The effect of PAT grafting on burn reconstruction has not yet been reported. Thus, in this study, we aimed to present our experience and discuss the role of PAT grafting in extremity burn reconstruction. METHODS: Between January 2019 and December 2020, 16 PAT grafting procedures were performed in 11 patients. All patients had second- or third-degree burns in the upper and lower extremities, with exposed bone or tendon. PAT grafts were harvested from the abdominal region and were used for the upper extremity in 7 patients and the lower extremity in 4 patients. Immediate skin grafting was performed during the same session. RESULTS: The patients' mean age was 50.7 years; defect size, 3.3 × 3 cm2; and follow-up time, 11.8 months. The survival rates of the PAT and skin grafts were 93.8% and 68.6%, respectively. Partial skin graft losses were encountered in 4 patients, and total skin graft loss was seen in 1 patient. CONCLUSION: PAT grafting is an alternative method to the use of dermal substitutes and flap surgery in small-to-medium-sized defects with exposed bone and tendon in burn patients.

Incorporating HPV 33 and cytology into HPV 16/18 screening may be feasible. A cross-sectional study.

PURPOSE: The distribution of human papillomavirus (HPV) varies geographically, and each country is making its screening and vaccination program. This study questioned the need for colposcopy for HPV types other than HPV 16 and 18, and the need for cytology incorporated into HPV testing. METHODS: 1043 consecutive patients referred for colposcopy are included in this retrospective study. Logistic regression analysis, ANOVA, and Pearson's correlation were used for statistical analysis. The value of p < 0.05 was considered statistically significant. RESULTS: HPV 16 was the most common HPV type referred, followed by HPV 18, 52, 51, and 31, respectively. HPV 16 tends to be positive in younger patients than other HPV types (p < 0.05). Only HPV 16 (OR: 1.41, 1.06-1.88 95% CI) and HPV 33 (OR: 2.23; 1.06-4.64 95% CI) (p < 0.05) had significant prediction for CIN 2 + lesions. In patients with only a cytological abnormality, cytological abnormality with single other high-risk (hr) HPV (without HPV 16 or 18) or double other hrHPV positivity but without HPV 16 and 18 infections, we detected 159 (19%) CIN 2 + lesions. CONCLUSION: HPV 33 may be implemented in hrHPV screening protocols for direct colposcopy referral as well as HPV 16 and HPV 18 in specific regions. If we had opted for HPV-based screening only for HPV 16 and 18 without cytology, 19% of all CIN 2 + lesions would have been missed. HPV-based screening only with HPV 16 and 18 may not be feasible. Nonavalent vaccines should be considered for the vaccination of specific populations.

The use of mathematically standardized bilobed design perforator flaps for coverage of sacral pressure ulcers.

BACKGROUND: Sacral pressure ulcer reconstruction is frequently applied in plastic surgery practice. Although perforator flaps are frequently used, recurrence is not uncommon in patients. For this reason, using the as little area as possible during the reconstruction is vital. Therefore, we aimed to describe a mathematically standardized bilobed perforator flap design for sacral pressure ulcer reconstruction with a certain proportion and angle relation between limbs. METHODS: A total of 17 patients (5 female/12 male)were included in this report. The mean age of the patients was 50.4 years (Ranging from 32 to 79 years). The patients with grade 3-4 sacral pressure ulcers were included in the report. The patients have grade 1-2 sacral ulcers or the other areas of pressure ulcer excluded. The size of the defects ranged from 8 × 14 cm to 5 x 16 cm. For ulcers in the sacral region, we used bilobed flaps that we mathematically standardized. The length of the first limb of the flap was planned 90° vertically oriented according to the distance between the perforator zone to the distal lateral border of the defect. The width of the first limb was kept equal to the length of the defect. The orientation of the second limb of the flap was designed 90 degrees horizontally according to the first limb. Therefore, the lengths of second limbs were calculated as half of the first limb's width, and the widths of second limbs were calculated as ¾ width of the first limb's width. RESULTS: A total of 10 flaps were elevated based on superior gluteal artery perforators, and seven flaps were nourished by inferior gluteal artery perforators. The mean size of the first limb of the flaps was 14.7 × 7.2 cm (Ranging from 8 to 20 × 6 to 13 cm). The mean size of the second limb of the flaps was 6.7 × 5.3 cm (Ranging from 5 to 12 × 4 to 8 cm). The mean size of defects was 10.5 × 7.3 cm (Ranging from 8 to 14 × 5 to 16). The mean rotation angle was 91.7° (ranging from 90 to 100). In the early postoperative period, the hematoma was detected in three patients and evacuated in one patient, resulting in wound separation. Tip necrosis was seen in a patient that was healed by wound care. No total flap loss was encountered. No late-term recurrence was seen during the follow-up. The mean follow-up time was 13.1 months (Ranging from 4 to 24 months). CONCLUSION: Unilateral standardized bilobed perforator can reliably be preferred in medium to large size sacral pressure ulcer defects.

Monitor selection according to the defect location in the medial femoral condyle flap.

BACKGROUND: Medial femoral condyle(MFC) flap is frequently used in hand reconstruction, but like other buried flaps, MFC is not easy to monitor and follow.In this study, we present our adipofascial and periosteal tissue technical modifications and results for MFC free flap monitoring and compare different monitoring methods. METHODS: Twenty one patients with wrist bone or metacarpal defect reconstructed with MFC flap were included in the study. Adipofascial tissue in wrist defect and periosteal tissue in metacarpal defect were selected as MFC flap's monitor. Patient characteristics, type of injury, flap size, early or late-period complications, flap elevation time,satisfaction scale, visual analogue scale (VAS) and postoperative X-ray view were noted. RESULTS: There were 3 female and 18 male patients in the study. The mean age of the patients was 50.8 (38-68). The elevation times of flaps with adipofascial and periosteal monitors were 48 and 53.3 min, respectively. The satisfaction scale averages for the adipofascial and periosteal monitor groups were 3.5 and 3.54, respectively. The VAS scores of the adipofascial and periosteal monitor groups were 2.9 and 3.9, respectively. The flap sizes with periosteal and adipofascial monitors were 10.48 cm3 and 1.36 cm3, respectively. There was no statistically significant difference between flap elevation, VAS, and satisfaction scale (>0.05). There was a statistically significant difference in flap sizes. (<0.05) CONCLUSION: MFC free flap is frequently used in wrist and metacarpal reconstruction. Monitor selection according to the defect area positively affects the prognosis of the flap in the postoperative period.

Use of Heparin Cream for Venous Congestion in the Extended Reverse Metacarpal Artery Flap: A Case Report.

Finger dorsum defects are a challenging situation. Many reconstruction methods are used in these defects. Extended reverse dorsal metacarpal artery (RDMA) flap is used in dorsal finger reconstruction. Venous congestion in this flap is most important cause of flap failure. In this case, we presented a case in which we used heparin cream due to development of venous congestion in our patient who underwent an extended RDMA flap. A 24-year-old female patient presented to the emergency department with a defect of dorsal of left-hand fourth finger. Defect was covered with an extended RDMA flap. On postoperative first day, venous congestion was observed, and heparin cream was applied three times a day on flap. The signs of venous congestion were regressed. Tissue healed as a result of superficial epidermolysis and skin grafting. No functional limitation was observed in sixth-month postoperative control. Venous congestion is the most important cause of flap failure of extended RDMA flaps. Generally, subcutaneous heparin administration and leech therapy are used. In our case, heparin was applied as a cream instead of subcutaneously, and flap healing was observed as a result of superficial epidermolysis. Heparin cream application can also be used as a treatment option in flaps with venous congestion.

The Effect of Adipose Derived Stromal Vascular Fraction on Flap Viability in Experimental Diabetes Mellitus and Chronic Renal Disease.

BACKGROUND: The presence of chronic renal disease(CRD) concurrently with diabetes mellitus(DM) increases the flap failure. Adipose derived stromal vascular fraction (SVF) is known to enhance skin flap viability in both healthy and diabetic individuals. The aim of this experimental study was to investigate the effect of SVF on skin flap viability in rats with DM and CRD. METHODS: 48 Sprague-Dawley rats were separated into four groups as follows: group I (control), group II (diabetes mellitus), group III (chronic renal disease), and group IV (diabetes with chronic renal disease).Two dorsal flaps were elevated. Flaps on left side of all groups received 0.5 cc of SVF, while same amount of plasma-buffered saline (PBS) was injected into right side. On postoperative day 7, flaps were harvested for macroscopic, histopathologic and biochemical assessments. Areas of flap survival were measured macroscopically. Blood level of vascular endothelial growth factor (VEGF) was measured after injection of SVF. RESULTS: Macroscopically, SVF has significantly improved flap viability (p < 0.05). Flap viability percentage was lower in DM and CRD groups when compared with healthy control group. In respect of new capillary formation, there was a statistically significant difference between SVF injected flaps and PBS injected sides (p < 0.05). Similarly, VEGF levels were higher in all study groups and there was a significant difference in comparison to control group (p < 0.05). CONCLUSIONS: The study showed that injection of SVF increased flap viability via endothelial differentiation and neovascularization. In vivo function of stem cells might be impaired due to uremia and diabetes-related microenviromental changes.

Salvage of Devascularized and Amputated Upper Extremity Digits with Temporary Ectopic Replantation: Our Clinical Series.

BACKGROUND: One of the reasons for unsuccessful replantation is recipient site problems. In cases where proximal stump status cannot be predicted exactly, reamputation may be required depending on the result of infection and tissue necrosis. The ectopic banking method has been defined for this type of injury. In this study, we presented the amputated or devascularized upper extremity digit ectopic banking application results in our clinical practice. METHODS: Nineteen digits (17 patients) banking ectopically were included in the study. All digits ectopically banked in the forearm volar of the non-injured upper limb. Transfers were made after waiting for the appropriate time. Ectopic banking periods, postoperative complications, and other descriptive data were recorded. In the postoperative 6th month, the range of motion (ROM) values of the digits were measured and compared with the ROM values of the same digit on the non-injured extremity.Also, in the postoperative 6th month, a questionnaire with a score of 1-5 was conducted for cosmetic results. RESULTS: The mean follow-up time was 13.6 months. The mean patient age was 39.5 years. The ectopic banking success rate is 94.1% (16/17). The orthotopic/heterotopic transfer success rate is 100% (17/17). Ectopic banking time is, on average, 19.2 days (min 5-max 55). Average cosmetic scale is 3.54. CONCLUSIONS: We think that the results of our study will shed light on surgeons who make ectopic banking applications.

The Roles of Injury Type, Injury Level and Amputation Type in the Need for Revision Surgery after Replantation: Retrospective Clinical Outcome with 296 Finger Replantation.

BACKGROUND: With the development of microsurgical techniques, the replantation survival rate has increased, but in some cases, revision surgery is required. Although there are many studies on replantation survival rate, studies on revision surgery are limited. In this study, we evaluated replantation patients requiring revision surgery in terms of amputation level, injury type, and amputation type (single-multiple). METHODS: This is a retrospective study.Two hundred fifty-six patients (296 fingers) who were operated on for total finger amputation in our hospital between 2013 and 2018 were included in the study. In the postoperative period, revision surgery was required for 24 fingers due to vascular insufficiency. Patients were evaluated in terms of amputation level, injury type, and amputation type. RESULTS: Two hundred sixty-four fingers were saved after primary surgery. Eight fingers failed before they could undergo revision surgery. Revision surgery was performed for 24 fingers. After revision surgery, 19 fingers were saved, and five fingers were failed. There was no significant effect of gender and age in terms of revision (p > 0.05).There was no statistically significant difference in injury level and injury type, but there was a statistically significant difference in terms of amputation type (p < 0.05). CONCLUSION: Despite advanced microsurgery and experience, vascular insufficiency can be observed after replantation. Surgical re-exploration is necessary for salvage.

Increased sulfiredoxin-1 levels as compensatory mechanism against reactive oxygen species in women with gestational diabetes mellitus

Objective: This study aimed to investigate the correlation between serum Sulfiredoxin-1 (Srx-1) levels and gestational diabetes mellitus (GDM). Materials and Methods: A total of 40 patients diagnosed with GDM according to the American Diabetes Association Criteria and 40 age matched and gestational age-matched healthy pregnant women as a control group were included in this cross-sectional study. Serum Srx-1 levels and other demographic and laboratory variables were analyzed. Results: Fasting plasma glucose, first and second-hour plasma glucose levels, fasting insulin levels, homeostasis model assessment of insulin resistance (HOMA-IR), and Srx-1 levels were significantly different in patients with GDM than control (p<0.05). Plasma Srx-1 levels significantly correlated with fasting plasma glucose, first and second-hour plasma glucose levels, fasting insulin levels, and HOMA-IR of patients with GDM (p<0.05), whereas no correlation in the control group. Conclusion: This is the first study demonstrating an association between serum Srx-1 levels and GDM. Our results suggest increased serum Srx-1 levels may be a novel predictive marker for GDM. More randomized-controlled trials are needed to evaluate Srx-1 as a marker for adverse fetal results; closer monitoring is warranted with high Srx-1 levels.

The association between increased maternal PARK7 (DJ-1) levels and the occurrence of preterm premature rupture of membranes - A randomized prospective study

Objective: Parkinson's disease protein 7 (PARK7/DJ-1) is an important antioxidant multiprotein against inflammation and oxidative stress. We therefore planned this study to demonstrate the association between maternal PARK7 levels and the occurrence of preterm premature rupture of membranes (PPROM). Materials and Methods: We enrolled 80 pregnant women; 50 PPROM patients and 30 healthy controls, into this cross- sectional study between the 24th and 36th gestational weeks. Furthermore, we measured serum PARK 7 levels using enzyme-Linked immunosorbent assay method. Results: Plasma PARK7 levels were higher in PPROM patients compared to those in the healthy controls (p<0.001). With a cutoff value of 2.57 pg/mL; PARK 7 had a 92% sensitivity, 86% specificity, 88% positive predictive value and 83% negative predictive value (p<0.01) for PPROM. PARK7 had positive correlation with blood leukocyte levels (p<0.001), C-reactive protein levels (p<0.001), and negatively correlated with birth weight and birth week. Conclusion: PARK 7 is overexpressed in PPROM patients. Due to its anti-inflammatory and antioxidant properties, PARK7 may be a novel marker in better understanding the pathophysiology and prediction of the prognosis PPROM. Further large-scale studies are needed.

The Effect of Ceruloplasmin Against Ischemia-Reperfusion Injury in Epigastric Island Flap in Rats.

BACKGROUND: Flap surgery is frequently used in plastic surgery to close tissue defects. Ischemia-reperfusion (I/R) injury is a significant problem resulting in partial or total flap necrosis. This study aimed to investigate the effect of ceruloplasmin on I/R injury in epigastric island flaps in rats. MATERIALS AND METHODS: A total of 32 male Sprague-Dawley rats were divided into four groups with eight rats in each group: The flap was not elevated in Group I; the flap was elevated without ischemia or any application in Group II, after the intraperitoneal saline and ceruloplasmin application the flaps were elevated and ischemia was created in group III-IV, respectively. Bilateral epigastric artery flap was elevated in all groups except Group I. After 6 h of ischemia, the flap was reperfused and inset. Samples were taken from the right and left side of the flap area in other groups at the postoperative 24th h for biochemical analysis (catalase and malondialdehyde-MDA) and the seventh postoperative day for histopathological analysis (Modified Verhofstad score and epidermal thicknesses), respectively. Image analysis for necrosis areas was performed on photos taken on the 7th d. RESULTS: Catalase level was significantly higher in Group IV.(0.15 ± 0.04 U/mg protein) (P < 0.05) Necrosis area percentage(14.4% ± 3.3%),MDA(3.6 ± 0.9 nmol/mg protein), edema(3), necrosis(2.75), and polymorphonuclear leukocyte infiltration(2.87) scores were significantly higher in group III.(P < 0.05). Fibroblast proliferation, collagen density (0.25), vascular density (0.25) scores and epidermal thickness (15.68 µm,) was significantly lower in group III. (P < 0.05) CONCLUSIONS: Our study demonstrated that ceruloplasmin application before ischemia reduced I/R injury in epigastric island flaps in rats.

The Effect of Botulinum Toxin on Flap Viability of the Posterior Thigh Perforator Flap in Rats.

BACKGROUND: The use of perforator propeller flaps in lower limb reconstruction has increased recently. Many pharmacological agents are used to increase flap viability. Botulinum toxin has been used in various types of flaps in the literature. However, there is no study regarding the use of botulinum toxin in the lower limb propeller flaps. This study investigates the effect of botulinum toxin administration on flap survival for lower limb propeller flap in rats. MATERIALS AND METHODS: The study included 20 male Wistar albino rats, divided into two groups with a flap rotation of 90° in group 1 and 180° in group 2. In both groups, botulinum toxin was administered to the right thigh and a physiological saline solution was applied to the left thigh. Five days later, flaps were elevated over the posterior aspect of the right and left thighs and inset after 90° and 180° rotation was performed. Histopathological, immunohistochemical, and necrosis area analyses were performed. RESULTS: Necrosis area, edema, polymorphonuclear leukocyte infiltration, and necrosis were found to be higher on the left side of the groups, whereas epidermal thickness, collagen density, vascularization, and hair root density were found to be higher on the right side of the groups. No significant difference was found between the right posterior thighs in either group on any parameter other than vascularization. Histopathologically and immunochemically statistically significant differences were found between the two groups. CONCLUSIONS: The present study found that botulinum toxin increases flap viability in lower limb perforator-based propeller flaps.